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St. Joseph’s Hospital of Atlanta conducts disaster drills three or four times a year, says registration supervisor Felicia Dafivbiroro, but it is another world since Sept. 11 for the access department and the rest of the hospital.
In the following days, and in the wake of mailed anthrax, the hospital has made some revisions to its response plan.
"We thought it would be a good time [to conduct a drill], and we did see some different things we should be doing," adds Dafivbiroro, who is a member of the hospital’s emergency preparedness committee.
Previously, for example, the procedure has been to contact the administrator on call when conditions warrant and have that person declare a disaster, she says. "That way, by the time we got the notification, the clearance [to put the disaster plan into effect], took about 20 minutes."
That meant a delay in deploying extra clinical and administrative staff to the emergency department (ED), Dafivbiroro adds, because those people don’t report until they hear the official declaration. "Now the ED physician present will make that decision."
A subcommittee of the emergency preparedness committee — charged with critiquing the response plan and suggesting revisions — also has pointed out the need for a method of assigning access staff to do follow-up on disaster victims, she says.
That step takes place after access staff receive an initial list from the triage area, Dafivbiroro notes. Complicating the process is the fact that the main admitting department is in a different area than the ED, she says.
St. Joseph’s disaster procedure is to have medical records personnel on duty with the triage nurse to get victims’ names and as much demographic information as possible, Dafivbiroro explains. Every 15 minutes, the medical records staff brings a list to admitters, who do a more complete registration and assign the patient a "real" medical record number that is then linked to the number they were given upon arrival.
That initial, temporary number is associated with the packet of information that is assigned to each disaster victim, she notes. In addition to a numbered armband, the packet contains clinical data sheets, informed consents, assignment of benefits documents, etc., all with the same number, Dafivbiroro says.
"If the triage nurse sends patients to other areas, we need to have one or two people working each of those areas," she adds, "and we need a method for deploying them to those areas."
Meanwhile, other access personnel will be working to obtain telephone consents and to gather additional patient information, Dafivbiroro explains. "Once we get additional information — from family members or as patients are able to give information — we update the list and send copies to the command center."
The committee also wants to find the best place to accommodate family members who are concerned that their loved ones may have been involved in the disaster, she adds. "We wanted somewhere that we didn’t have to install new telephone lines," Dafivbiroro says, noting that an auditorium first considered for the purpose would have required more lines.
Now, she adds, the hospital is looking at using five classrooms on the ground floor beneath the ED as a place where families can come for information.
The most recent drill, which dealt with a hypothetical smallpox outbreak, highlighted the fact that because the ED would be contaminated and therefore under quarantine, a runner would not be able to take information back and forth between there and the command center, Dafivbiroro says.
"In the future we will use fax machines, wireless phones, and the Internet to communicate," she says. "If you only have one or two or three phone lines, you need to come up with alternate ways."
Because of the possibility of contaminated mail, she notes, St. Joseph’s now provides protective gowns, masks, and gloves in areas that don’t normally have contact with patients.
"Just as a precaution, it is recommended that those who work in the mailroom or open mail wear gloves and masks," Dafivbiroro says. That includes financial counselors who open mail from customers, she adds.